Association of ultra-processed food consumption with all cause and cause specific mortality: population based cohort study
BMJ 2024; 385 doi: https://doi.org/10.1136/bmj-2023-078476 (Published 08 May 2024) Cite this as: BMJ 2024;385:e078476Linked Editorial
Ultra-processed foods linked to higher mortality
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Dear Editor,
As ultra-processed foods flood our diets, a hidden health crisis is emerging—one that’s disproportionately impacting Black, Asian, and Minority Ethnic (BAME) communities. While these quick, calorie-packed foods pose health risks for everyone, the toll they take on BAME communities is deeper and more complex. Beneath the surface of what seems like a modern dietary trend, there’s a web of genetic, socioeconomic, and environmental factors that make this crisis uniquely urgent for these populations.
Ultra-processed foods, rich in sugars, unhealthy fats, refined carbs, and additives, are convenient but ultimately damaging, especially for those who consume them in high quantities. In the U.S., these foods now account for a shocking 57% of the daily caloric intake for adults and even more for youth. But this isn’t just about convenience—it's a systemic issue that’s feeding into health disparities, particularly affecting BAME communities.
Studies reveal that in Western nations like the UK and US, BAME communities face higher rates of obesity, diabetes, heart disease, and other chronic illnesses compared to their Caucasian counterparts. Genetics play a role, too. For example, South Asians often show what’s known as a “thin-fat” phenotype, where they might appear lean but carry more hidden, dangerous fat around their organs. This makes them more prone to metabolic issues and heart problems, even at lower body weights. So, a South Asian person eating the same diet as a Caucasian peer may face a higher risk of diabetes or heart disease due to these genetic factors.
And then there’s the socioeconomic angle. Many BAME communities deal with economic challenges that make healthier options hard to afford. In urban areas, where access to fresh, affordable produce is often limited, cheap, calorie-dense processed foods become the default choice. While Caucasian communities also experience food insecurity, they generally have a wider range of food choices and resources, which can cushion the health impact somewhat. But for BAME communities, this reliance on ultra-processed food isn’t just about convenience or taste—it’s often a matter of necessity.
These factors only scratch the surface of a much larger issue. The reality is that ultra-processed food consumption among BAME communities represents just the tip of an iceberg. Beneath the waterline, we’re looking at a crisis that’s fueled by layers of historical, environmental, and genetic factors. This isn’t just a dietary problem; it’s a public health emergency.
To tackle this, we need a public health strategy that’s both broad and deeply respectful of cultural diversity. Health campaigns must reach people where they are, providing relevant and culturally sensitive information. Partnering with community leaders and creating programs that resonate with specific cultural needs can make healthy eating a reality for everyone.
Government policies have a role to play, too. Subsidizing fresh produce in lower-income areas and enforcing stricter rules on marketing unhealthy foods to children could make a significant difference. And, importantly, we need more research on how diet affects different ethnic groups and how traditional foods can be integrated into healthier eating patterns, especially for BAME populations.
This challenge requires more than just updated dietary guidelines. It calls for an approach that directly addresses the unique struggles facing BAME communities in our food systems. The health risks associated with ultra-processed foods are serious for everyone, but they’re amplified for BAME individuals by layers of socioeconomic and genetic factors. By adopting a targeted, culturally informed strategy, we can work towards truly equitable health outcomes.
Our food choices shape our health, and the choices we have are shaped by the systems around us. Recognizing and addressing the unique vulnerabilities of BAME communities isn’t just about food—it’s about health, equity, and a fairer future for all.
Competing interests: No competing interests
Dear Editor:
We appreciate readers’ interest in our work and in the link between ultra-processed food (UPF) and health. We would like to clarify a few issues raised by the readers, in particular regarding the adjustment of total energy intake, BMI and dietary quality score commented by Dr. Rezende and Dr. Monterio.
There are several reasons why total energy intake is often adjusted when FFQ is used to assess diet-disease relationship: (1) adjusting for total energy can mitigate measurement errors which, such as over/under-reporting in intake, tend to be highly correlated among multiple foods; (2) the goal is generally to assess diet composition, rather than total energy intake, as the exposure; and (3) total energy intake might act as confounder since high energy needs influence the amount of foods consumed.
In eTable 6, we showed that not adjusting for BMI did not alter the hazard ratios (HRs) for all-cause or cancer mortality, slightly weakened the associations for CVD mortality, and slightly strengthened the associations for respiratory and neurodegenerative mortality. Overall, adjustment for BMI did not make a meaningful change in our results.
No adjustment of AHEI score may lead to confounding while adjustment may lead to overadjustment. By conducting a joint examination of the AHEI score and UPF consumption and by further adjusting for the AHEI score in the multivariable model as the sensitivity analysis, we intended to explore the relative importance of food processing level and dietary quality in terms of mortality. We agree that AHEI score and UPF consumption share several food components and thus have acknowledged in the discussion that adjustment of AHEI may have led to overadjustment.
Regarding Dr. Monterio’s comment about change in associations due to dietary score adjustment, upon further examination of published studies [1], most were conducted in Europe and adjusted for population/geographic-specific dietary scores (the one US study did not report changes in effect estimates). The varying degree of overlap between the dietary score used and UPF consumption in each population may have contributed to the variation in change in associations due to dietary score adjustment. Another reason why previous studies did not report change in associations due to dietary score adjustment is that the observed associations without dietary score adjustment were strong and the attenuation in effect estimates did not alter the statistical significance. By contrast, in our study, UPF was only weakly associated with increased mortality risk and thus the change in HRs after adjusting for AHEI scores, while not substantial (eTable 6), attenuated the associations towards the null.
While there is growing evidence linking UPF consumption to poor health outcomes, it remains crucial to identify the specific attributes driving that—poor nutritional quality, physicochemical properties and structural changes, etc. Several mechanisms have been suggested. First, UPF is usually energy-dense and disproportionately contributes added sugars, sodium, saturated and trans-fats, and refined carbohydrates to the diet together with low fiber [2,3]. Besides, UPF may contain harmful chemical substances. Studies documented that industrial additives commonly present in UPF, such as titanium dioxide and artificial sweeteners, are linked to chronic inflammation, carcinogenesis, and gut dysbiosis [4,5]. A cohort study showed that two emulsifier groups were associated with higher risk of CVD [6]. Furthermore, regarding the hypothesis of high-temperature process raised by Dr. Bhopal, contaminants formed in the high-temperature heating and extruding, such as acrylamide and acrolein metabolites, could be carcinogenic and genotoxic [7,8], although it should be noted that acrylamide is not unique to UPF and can also be present in cooking with high heat. There also exists hormone-disrupting chemical compounds leached from plastic food manufacturing and packaging materials (e.g., bisphenol A) [9].
Reference
1. Dicken, S. J., & Batterham, R. L. (2021). The Role of Diet Quality in Mediating the Association between Ultra-Processed Food Intake, Obesity and Health-Related Outcomes: A Review of Prospective Cohort Studies. Nutrients, 14(1),23. doi: 10.3390/nu14010023.
2. Poti, J. M., Mendez, M. A., Ng, S. W., & Popkin, B. M. (2015). Is the degree of food processing and convenience linked with the nutritional quality of foods purchased by US households? Am J Clin Nutr, 101(6), 1251-1262, doi:10.3945/ajcn.114.100925.
3. Monteiro, C. A., Cannon, G., Moubarac, J. C., Levy, R. B., Louzada, M. L. C., & Jaime, P. C. (2018). The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr, 21(1), 5-17, doi:10.1017/s1368980017000234.
4. Suez, J., Korem, T., Zeevi, D., Zilberman-Schapira, G., Thaiss, C. A., Maza, O., et al. (2014). Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature, 514(7521), 181-186, doi:10.1038/nature13793.
5. Carbon black, titanium dioxide, and talc (2010). IARC Monogr Eval Carcinog Risks Hum, 93, 1-413.
6. Sellem, L., Srour, B., Javaux, G., Chazelas, E., Chassaing, B., Viennois, É., ... & Touvier, M. (2023). Food additive emulsifiers and risk of cardiovascular disease in the NutriNet-Santé cohort: prospective cohort study. bmj, 382, doi: 10.1136/bmj-2023-076058.
7. Ou, J., Zheng, J., Huang, J., Ho, C. T., & Ou, S. (2020). Interaction of Acrylamide, Acrolein, and 5-Hydroxymethylfurfural with Amino Acids and DNA. J Agric Food Chem, 68(18), 5039-5048, doi:10.1021/acs.jafc.0c01345.
8. EFSA Panel on Contaminants in the Food Chain (CONTAM). (2015). Scientific opinion on acrylamide in food. Efsa Journal, 13(6), 4104, doi:https://doi.org/10.2903/j.efsa.2015.4104.
9. Buckley, J. P., Kim, H., Wong, E., & Rebholz, C. M. (2019). Ultra-processed food consumption and exposure to phthalates and bisphenols in the US National Health and Nutrition Examination Survey, 2013-2014. Environ Int, 131, 105057, doi:10.1016/j.envint.2019.105057.
Competing interests: No competing interests
Dear Editor
We read with interest the article by Fang et al. (Association of ultra-processed food consumption with all cause and cause specific mortality: population based cohort study BMJ 2024; 385 doi: https://doi.org/10.1136/bmj-2023-078476 (Published 08 May 2024)). This found that the consumption of ultra-processed food in adults is associated with higher mortality. We would like to draw attention to the digital marketing of ultra-processed food, particularly to adolescents.
The digital marketing of food products to adolescents on platforms such as Instagram and Facebook is designed to be frequent, appealing, and compelling to increase sales (1). This type of marketing displays appealing features and persuasive techniques (such as likes, comments, logos, hashtags, special offers and use of celebrities) that alter adolescents' food preferences, attitudes, and purchasing intentions. The global impact of social media food marketing on adolescents' food preferences underscores the urgent need for regulation. However, despite the heavy use of social media for marketing, regulation in many countries primarily focuses on television marketing (2). Urgent attention to the digital marketing of ultra processed food to adolescents is needed given that unhealthy food preferences pose a risk for various chronic diseases in childhood, including childhood obesity. Obese children are more likely to become obese adults (3). Thanks to Fang and colleagues we now know that a higher intake of ultra-processed food in adults is also associated with higher all cause, and cause specific mortality. We call for greater regulation of social media food marketing targeting children and adolescents across all age ranges to improve population health.
Okechukwu Paschal Ezejibuaku MPH
John Oldroyd PhD
Australian Catholic University
References
1. Harris, J. L., Yokum, S., & Fleming-Milici, F. (2021). Hooked on junk: emerging evidence on how food marketing affects adolescents’ diets and long-term health. Current Addiction Reports, 8, 19- 27. https://doi.org/10.1007/s40429-020-00346-4
2. Kucharczuk, A. J., Oliver, T. L., & Dowdell, E. B. (2022). Social media's influence on adolescents' food choices: a mixed studies systematic literature review. Appetite, 168, 105765. https://doi.org/10.1016/j.appet.2021.105765
3. Naderer, B. (2021). Advertising unhealthy food to children: on the importance of regulations, parenting styles, and media literacy. Current Addiction Report, 8, 12–18. https://doi.org/10.1007/s40429-020-00348-2
Competing interests: No competing interests
Dear Editor,
This was a mortality study with what seems like good intentions. However if one is looking at mortality, I would think excluding the most common causes of mortality in the baseline groups would have a tremendous effect on the outcome of the study. 39% of women and 23% of men were excluded for having one of the common American chronic diseases (Cardiovascular disease, Diabetes, or Cancer) or improperly filling out their 2 year questionnaires. Normally studies look at the high risk patients to help get a better statistical result. This study suggests that lower risk (of getting a chronic disease) men and women have a slightly higher mortality when they report eating more highly processed foods.
Greg Rice MD
Clinical Associate Professor Emeritus
Department of Family Medicine
University of Washington School of Medicine
Competing interests: No competing interests
Dear Editor
We read the article by Fang and colleagues with great interest, but what about ultra-processed foods (UPFs) in childhood? A recent large cross-sectional study revealed that UPFs consumption in childhood is positively associated with BMI z-scores, waist circumference, fat mass index, and fasting plasma glucose concentration (1). Additionally, it is inversely associated with HDL cholesterol concentration. Socioeconomic and educational factors also influence UPFs consumption, further increasing the risk of cardiometabolic disorders.
Both studies underscore the importance of dietary habits and their potential impact on future cardiometabolic health. Although the clinical relevance of these associations may be modest, the high population consuming UPFs should be emphasized. It can compensate for the modest association. Eating habits serve as crucial indicators of future health risks. Therefore, promoting healthier food choices and addressing UPFs consumption from childhood is essential to mitigating future cardiometabolic conditions.
1. Khoury N, Martínez MÁ, Garcidueñas-Fimbres TE, et al. Ultraprocessed Food Consumption and Cardiometabolic Risk Factors in Children. JAMA Netw Open. 2024;7(5):e2411852. doi:10.1001/jamanetworkopen.2024.11852
Competing interests: No competing interests
Dear Editor
Using Harvard cohort’ data, Fang et al.[1] reported results on the association between ultra-processed food consumption and mortality outcomes. Their finding on the direct association with all-cause mortality was consistent with the literature,[2] but the null association with cardiovascular mortality was not.[2] In addition, Fang et al found that the association between ultra-processed food consumption and all-cause mortality was eliminated after adjustment for diet quality (Alternative Healthy Eating Index -AHEI). No changes in the same association have been reported in prospective studies conducted in Spain and Italy, adjusting for the Mediterranean Dietary pattern, in France, adjusting for the French dietary guidelines score, and in the US, adjusting for the Nutrient-Rich Food index.[3]
Fang et al mentioned better control of confounders and differences with other countries in the mix of ultra-processed foods as potential explanations for findings inconsistent with the literature. Although acknowledged, overadjustment of associations in models adjusting for body mass index or AHEI was not given as an additional explanation.
In fact, most multivariable models performed in the study were probably overadjusted due to inclusion of potential mediators of the association between UPF and mortality: total energy intake and body mass index, both causally related to UPF consumption[4], and the AHEI itself, which considers critical nutrients heavily influenced by the intake of ultra-processed foods[5], and sugared beverages and processed meat products, two contributors of UPF consumption.
Notably, in sensitivity analysis that excluded BMI adjustment, Fang et al. found a significant direct association of ultra-processed food consumption with both all-cause and cardiovascular mortality. Additional multivariable models not adjusted for other potential mediators of the associations or exposure contributors could provide useful information to interpret the study results and also better align its findings and conclusions with the literature.
References
1. Fang Z, Rossato SL, Hang D, Khandpur N, Wang K, Lo CH, Willett WC, Giovannucci EL, Song M. Association of ultra-processed food consumption with all cause and cause specific mortality: population based cohort study. BMJ. 2024 May 8;385:e078476. doi: 10.1136/bmj-2023-078476.
2. Lane MM, Gamage E, Du S, Ashtree DN, McGuinness AJ, Gauci S, Baker P, Lawrence M, Rebholz CM, Srour B, Touvier M, Jacka FN, O'Neil A, Segasby T, Marx W. Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses. BMJ. 2024 Feb 28;384:e077310. doi: 10.1136/bmj-2023-077310.
3. Dicken SJ, Batterham RL. The Role of Diet Quality in Mediating the Association between Ultra-Processed Food Intake, Obesity and Health-Related Outcomes: A Review of Prospective Cohort Studies. Nutrients. 2021 Dec 22;14(1):23. doi: 10.3390/nu14010023.
4. Hall KD, Ayuketah A, Brychta R, Cai H, Cassimatis T, Chen KY, Chung ST, Costa E, Courville A, Darcey V, Fletcher LA, Forde CG, Gharib AM, Guo J, Howard R, Joseph PV, McGehee S, Ouwerkerk R, Raisinger K, Rozga I, Stagliano M, Walter M, Walter PJ, Yang S, Zhou M. Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake. Cell Metab. 2019 Jul 2;30(1):67-77.e3. doi: 10.1016/j.cmet.2019.05.008.
5. Martini D, Godos J, Bonaccio M, Vitaglione P, Grosso G. Ultra-Processed Foods and Nutritional Dietary Profile: A Meta-Analysis of Nationally Representative Samples. Nutrients. 2021 Sep 27;13(10):3390. doi: 10.3390/nu13103390.
Competing interests: No competing interests
Dear editor,
Ultra-processed foods: is high heat potential mechanism for harm?
The association between ultra-processed foods and health outcomes is proving difficult to pin down and the latest findings on all-cause cause specific mortality by Fang et al are surprising given, unexpectedly, weak associations for cancer and cardiovascular diseases and stronger ones for other causes including respiratory and neurodegenerative ones.[1] In their linked editorial, Bradbury and Mackay point to potential mechanisms whereby a ultra-processed foods might do harm, including additives and contaminants.[2]
I propose an idea that has support from nutritional sciences and epidemiology but to my knowledge has not been incorporated into discussions about ultra-processed foods i.e., production processes involving high heat.[3-5] High heat cooking/processing results in the creation of a myriad of new compounds that are associated with a range of adverse metabolic outcomes including chronic diseases e.g. transfatty acids, advanced glycation end products and acrylamides. These processes are accelerated as temperatures rise and have important effects at 170°C and above. High heat is particularly important for processing meat and other flesh products which were particularly associated with adverse outcomes in Fang et al.’s study.[1]
With colleagues, I have published hypotheses that such high heat cooking/food processing might explain the very high rates of cardiovascular and chronic renal failure in South Asians.[6-8]
Future labelling of foods might need to include the temperature at which the food is cooked and the major, potentially harmful new compounds produced in the processing. The adverse effects of high heat cooking are well established in the scientific literature, including animal and human trials but seldom make it to mainstream discussion. The alignment of research on ultra-processed foods and high heat cooking could catalyse advances in both fields.
Raj S Bhopal, Emeritus Professor of Public Health
Usher Institute, Medical School, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG
Institute website:
http://www.ed.ac.uk/usher
The University of Edinburgh is a charitable body, registered in Scotland, with registration number SC005336
1. Fang Z, Rossato SL, Hang D, et al. Association of ultra-processed food consumption with all cause and cause specific mortality: population based cohort study. 2024;385:e078476. doi: 10.1136/bmj-2023-078476 %J BMJ
2. Bradbury KE, Mackay S. Ultra-processed foods linked to higher mortality. 2024;385:q793. doi: 10.1136/bmj.q793 %J BMJ
3. Khan MI, Min JS, Lee SO, et al. Cooking, storage, and reheating effect on the formation of cholesterol oxidation products in processed meat products. Lipids Health Dis 2015;14:89. doi: 10.1186/s12944-015-0091-5 [doi];10.1186/s12944-015-0091-5 [pii]
4. Tessier FJ, Birlouez-Aragon I. Health effects of dietary Maillard reaction products: the results of ICARE and other studies. Amino Acids 2012;42(4):1119-31. doi: 10.1007/s00726-010-0776-z [doi]
5. Birlouez-Aragon I, Saavedra G, Tessier FJ, et al. A diet based on high-heat-treated foods promotes risk factors for diabetes mellitus and cardiovascular diseases. American Journal of Clinical Nutrition 2010;91(5):1220-26.
6. Bhopal RS. Epidemic of Cardiovascular Disease and Diabete: explaining the phenomenon in South Asians worldwide. Oxford: Oxford University Press 2019.
7. Krishan P, Bhopal RS, Vlassopoulos A, et al. Could high heat cooking and food processing promoting neo-formed contaminants partially explain the high prevalence of chronic kidney disease in South Asian populations? A hypothesis. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2022;16(2):102398. doi: https://doi.org/10.1016/j.dsx.2022.102398
8. Kakde S, Bhopal RS, Bhardwaj S, et al. Urbanized South Asians' susceptibility to coronary heart disease: The high-heat food preparation hypothesis. Nutrition 2017;33:216-24. doi: 10.1016/j.nut.2016.07.006
Competing interests: No competing interests
Dear Editor
The piece by Fang et al. is a welcome examination of the association between ultra-processed food consumption with all-cause mortality and cause-specific mortality. The key reported quantities of interest are adjusted hazard ratios (HRs) comparing mortality outcomes for those in the highest quarter of ultra-processed food consumption to those in the lowest quarter. The claim is made that, while participants in the highest quarter had a 4% higher risk of total deaths and 9% higher risk of deaths from other causes (excluding cardiovascular diseases and cancer), no such associations were found for deaths due to cardiovascular diseases, cancer, or respiratory diseases.
This latter part of this claim, however, is not supported by the evidence. Rather than no association, the reported modeled risk is 5% higher for deaths due to cardiovascular diseases, 5% lower for deaths due to cancer, and 9% higher for deaths due to respiratory diseases. These risks are not zero and are of similar magnitude to those described as existing and worth reporting.
The reason for the discrepancy between the evidence and the characterization of the findings is that binary statistical declarations are inappropriately conflated with scientific conclusions. In this case, 95% confidence intervals for the HRs that just barely overlap with 1.00 (e.g., 1.00, .99, and .99) are conflated with substantive conclusions of no association. For all-cause mortality, the lower bound of the confidence interval at 1.01 doesn’t quite make it there. From an evidentiary standpoint, however, the ranges of plausible true HRs that are compatible with the data are similar for various types of mortality. The overarching concern is that we should not conclude that the results (e.g., cause-specific mortality risks) are different because of differences in statistical significance [1]. Knowledge generation and associated clinical recommendations depend on scientific summaries that have fidelity to the evidence.
1. Valentin A, Sander G, Blake M. Retire statistical significance. Nature (London). 2019;567(7748):305-7. doi: 10.1038/d41586-019-00857-9
Competing interests: No competing interests
Dear Editor
The association between ultra-processed foods (UPF) consumption and a higher mortality risk has been replicated in the epidemiological study featured by Fang and colleagues.[1] However, the question remains whether food processing is an underlying cause. Multivariable adjustments for total calories and dietary healthiness (Alternative Healthy Eating - AHEI) were performed to disentangle food processing from diet quality. Subgroup analyses were performed to investigate whether certain types of UPF pose a greater risk than others.
These scientifically relevant questions have profound implications for public health actions but are challenging to respond to with observational epidemiology alone. For instance, an in-patient, cross-over, randomized controlled trial comparing ad libitum intake of ultra-processed vs unprocessed diets showed that UPF is less satiating and leads to overconsumption and weight gain, likely due to additive content, altered texture, taste, and satiety.[2] Therefore, Fang et al.’s adjustment for potential mediators in the main model, such as total calories and body mass index (BMI), likely underestimated the association between UPF and mortality, particularly all-cause and cardiovascular disease mortality. In addition, adjustment for AHEI (sensitivity analysis) and joint association of UPF and AHEI may also represent an over-adjustment as components of AHEI were incorporated into the UPF category (e.g., sugar-sweetened beverages and processed meat). Of note, joint associations were not formally tested for multiplicative interaction and included total caloric intake and BMI in the model.
Finally, subgroup analyses suggested that certain UPFs drove associations observed, whereas other UPFs were null or protective (dark chocolate). When associations are observed in epidemiological studies, confounding is a concern, and the effects of different constituents of foods are particularly challenging to distinguish. On the other hand, dietary patterns (e.g., ultra-processed dietary patterns) associations are less problematic as displacement by other constituents of foods is part of the expected mechanism.
References
1. Fang Z, Rossato SL, Hang D, Khandpur N, Wang K, Lo CH, Willett WC, Giovannucci EL, Song M. Association of ultra-processed food consumption with all cause and cause specific mortality: population based cohort study. BMJ. 2024;385:e078476. doi: 10.1136/bmj-2023-078476.
2. Hall KD, Ayuketah A, Brychta R, Cai H, Cassimatis T, Chen KY, Chung ST, Costa E, Courville A, Darcey V, Fletcher LA, Forde CG, Gharib AM, Guo J, Howard R, Joseph PV, McGehee S, Ouwerkerk R, Raisinger K, Rozga I, Stagliano M, Walter M, Walter PJ, Yang S, Zhou M. Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake. Cell Metab. 2019;30(1):67-77.e3. doi: 10.1016/j.cmet.2019.05.008.
Competing interests: No competing interests
Lab-Grown Meat: Sustainable Innovation or Ultra-Processed Hazard?
Dear Editor
Lab-grown meat is often promoted as a sustainable and ethical alternative to conventional meat, with potential benefits for reducing greenhouse gas emissions and eliminating the need for animal slaughter. However, it raises crucial health concerns as an ultra-processed food (UPF) under the NOVA classification (1). Fang et al. found that higher consumption of UPFs is associated with increased overall mortality, mainly from causes other than cancer and cardiovascular diseases (2). These results suggest that, while lab-grown meat may have environmental advantages, its classification as an ultra-processed food demands caution in assessing long-term health impacts.
According to NOVA, ultra-processed foods are industrial formulations made mostly or entirely from substances derived from food, with minimal or no whole-food content (1). They typically include additives such as flavor enhancers, stabilizers, emulsifiers, and synthetic ingredients designed to enhance texture, color, and taste. Lab-grown meat fits this definition because it is created using biotechnological processes in bioreactors, requiring growth media, scaffolds, and structural agents to replicate the texture and flavor of conventional meat. Although marketed as “real meat,” the level of processing involved distances it from traditional, whole-food sources.
This BMJ study analyzed data from over 110,000 participants across more than 30 years, finding that those consuming the highest amounts of UPFs had a 4% higher overall mortality risk and a 9% higher mortality risk from non-cancer and non-cardiovascular causes. While the study did not specifically investigate lab-grown meat, it highlighted the strongest associations with mortality for processed meat products, sugary beverages, and dairy-based desserts. Given that lab-grown meat is processed to achieve sensory characteristics similar to industrially processed meats, it may share some of the same risks.
Despite its potential for sustainability, lab-grown meat production is highly energy-intensive, raising concerns about whether it will genuinely reduce environmental impacts at scale. Regulatory agencies, including the UK Food Standards Agency (FSA), are evaluating lab-grown meat for safety, particularly regarding residual growth factors, genetic stability, and potential unintended contaminants. The first approvals were granted in Singapore, the United States, and Israel, while Italy and Florida banned lab-grown meat due to concerns related to safety and food sovereignty (3).
Overall, lab-grown meat represents an intriguing innovation, but its classification as an ultra-processed food warrants careful scrutiny. While it could play a role in reducing livestock emissions and improving animal welfare, its long-term health effects remain unknown. This BMJ study reinforces concerns about the chronic health impacts of diets high in ultra-processed foods, making it crucial to evaluate lab-grown meat beyond environmental and ethical considerations. As with any new food technology, truth, transparency, and scientific rigor should guide its adoption.
References
1. Monteiro CA, Cannon G, Levy RB, et al. Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019;22(5):936-941. doi:10.1017/S1368980018003762.
2. Fang Z, Rossato SL, Hang D, et al. Association of ultra-processed food consumption with all cause and cause specific mortality: population based cohort study. BMJ. 2024;385:e078476. doi:10.1136/bmj-2023-078476.
3. Carrington D. Lab-grown meat could be sold in UK in next few years, says food regulator. The Guardian. 8 October 2024. Available at: https://www.theguardian.com.
Competing interests: No competing interests